Disorders of Laughter Due to Brain Lesions

Ironside, Redvers

doi:10.1093/brain/79.4.589

Cited by 136 publications

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“…As a wider one, it is safer to consider as pathological any production of laughter without the appropriate stimulus, either external (humorous) or internal (thoughts), at inappropriate situations and without voluntary control 1,2 . Differentiation must be made from emotional liability or emotional incontinence, in which laughter and crying alternate as an expression of the patient's true (and pathological) affective state.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, pathological laughter is associated with a structural lesions or functional disorders of the central nervous system. Propedeutically, it is important to obtain from the patient if there is a sense of mirth preceding laughter or if it comes merely as a motor phenomenon 2,3 . Patients sensing mirth probably present with a lesion affecting higher levels of function, including the circuit of Papez.…”

Section: Discussionmentioning

confidence: 99%

“…It receives afferences from cortical and subcortical structures which work as modulators of emotional responses. Diffuse lesions that interrupt the corticohypothalamic tracts produce neurological syndromes marked by loss of control over the emotional expressions, such as pseudobulbar palsy 2 …”

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confidence: 99%

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Pathological laughter in a patient with trigeminal neurinoma

Machado

Aguiar

Marino

2002

Arq. Neuro-Psiquiatr.

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-We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.KEY WORDS: pathological laughter, neurinoma, trigeminal neuralgia. Riso patológico em uma paciente com neurinoma de trigêmeoRESUMO -Relatamos o caso de uma paciente de 47 anos com história de longa data de ansiedade que apresentou início de dor facial em choques do lado direito e episódios de riso sem motivação. Ela não podia explicar os episódios de riso e não percebia uma sensação de graça que os precedia. Ao exame neurológico apresentava paresia do VI nervo e hipoestesia no trajeto dos ramos oftálmico e maxilar do trigêmeo. A ressonância magnética de encéfalo apresentava uma lesão cística na fossa média direita causando significativo efeito de massa sobre o tronco encefálico. Um acesso combinado fronto-orbito-zigomático e pré-temporal foi realizado e a exploração intra e extra-dural revelou um grande tumor no nervo trigêmeo. Toda a lesão foi ressecada, revelando ser um neurinoma no exame patológico. A paciente manteve a paresia de VI nervo mas apresentou remissão completa dos episódios de riso imotivado durante o seguimento de um ano. PALAVRAS-CHAVE: riso patológico, neurinoma, neuralgia trigeminal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathological laughter in a patient with trigeminal neurinoma

Machado

Aguiar

Marino

2002

Arq. Neuro-Psiquiatr.

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“…Traditionally smiling has been considered a voluntary phenomenon of facial expression related to mirth and happiness, and it has not been clearly defined as an epileptic sign. Gelastic seizures, with laughter as their main and characteristic manifestation, have been extensively documented and described in the medical literature (1)(2)(3). Ictal laughter has been associated basically with three pathologic situations: patients with hypothalamic hamartomas (often associated with precocious puberty; 4), patients with complex partial seizures of suspected temporal origin (1,(5)(6)(7), and children with infantile spasms (8).…”

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confidence: 99%

Ictal Smile

Molinuevo

Arroyo

1998

Epilepsia

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Feelings of merriment, laughter, and smile are occasionally manifested during seizures. Traditionally smiling has been considered a voluntary phenomenon of facial expression related to mirth and happiness, and it has not been clearly defined as an epileptic sign. Gelastic seizures, with laughter as their main and characteristic manifestation, have been extensively documented and described in the medical literature ( 1-3). Ictal laughter has been associated basically with three pathologic situations: patients with hypothalamic hamartomas (often associated with precocious puberty; 4), patients with complex partial seizures of suspected temporal origin (1,(5)(6)(7), and children with infantile spasms (8).Smiling as an ictal manifestation has not been clearly recognized and, therefore, smiling seizures have not been linked to any specific localization. In this report we analyze the utility of an ictal smile for localization of an epileptogenic focus. PATIENTS AND METHODSWe reviewed the video-EEG recordings of 86 consecutive patients referred to our Epilepsy Monitoring Unit during 1995 and 1996 to look for partial seizures with a smile as part of their ictal semiology. Ictal smile was defined as a concordant facial expression during a seizure, which usually translates happiness and is clearly distinct from a tonic deviation of the mouth or other abnormal tonic-clonic movements involving the face. We determined that the most important criterion for defining ictal smile was the similarity of the ictal expression to the normal smile of the patient.Patients were monitored continuously with a 24-h video-EEG monitoring system using a 64-channel Nicolett BMSI 5000 (Madison, WI, U.S.A.). EEG electrodes were placed by following the international 10/10 system. We used 44-64 EEG channels for seizure recording. During monitoring, the patient's current antiepileptic medication (AED) was withdrawn to facilitate seizures. Localization of the epileptogenic area was performed through EEG analysis, magnetic resonance imaging (MRI, Magneton SP Siemens, 1.5 Teslas) and ictal and interictal 9 9 m T~ hexamethylpropyleneamine oxime (HM-PAO) single-photon-emission computed tomography (SPECT) (Elseint Helix, double-head gamma camera fitted with fan beam collimators). RESULTSSmiles were manifested in five patients during seizures. None of them had a history of gelastic epilepsy nor was ictal laughter detected in any patient. Three were male and two female patients. Their mean age was 29.8 years (from 23 to 36 years), and their mean age at seizure onset was 13.4 ? 5.1 years. All patients had simple or complex partial seizures. The location, MRI findings, and etiology are shown in Table 1.The five patients had a total of 39 seizures during the Two of the patients experienced simple partial seizures in addition to the complex partial seizures: in patient l with parietal lobe onset, simple partial seizures were characterized by a smile without feeling of mirth associated with a feeling of depersonalization, and in patient 2 with temporal lobe-ons...

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“…Goldstein [7] az 1930-as években leírt egy elsősorban bal oldali laesiót követő "katasztrófareakciót", Babinski [8] pedig a jobb oldali agyfélteke károsodása után fellépő "emocionális indifferenciára" hívta fel a fi gyelmet. Ironside [9] az " affektinkontinenciát" írta le a corticobulbaris pályák bilateralis sérülésekor. Az elmúlt három évtized kutató-munkájának köszönhetően ma már egyértelműen elfogadott a PSD létezése és klinikai jelentősége.…”

Section: Folstein éS Munkatársaiunclassified

Post-stroke depression

Schulte-Altedorneburg

Bereczki

2014

Orvosi Hetilap

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A cerebrovascularis megbetegedéseket gyakran követik pszichiátriai, neuropszichiátriai kórképek, amelyek közül a poststroke-depresszió fordul elő a leggyakrabban. A poststroke-depresszió gyakorisága a stroke-ot követő első év során 30-35%-ra tehető. A szerzők az irodalmi adatok alapján áttekintik az agyi vérkeringészavart követő hangulatzavar prevalenciáját, patogenezisét, prediszponáló tényezőit, terápiás lehetőségeit. Az utóbbi időben egyre több közlemény felveti a prevenció lehetőségét is. A magas prevalencia ellenére az agyi vérkeringészavart követő hangulatzavart gyakran nem ismerik fel, a kezelés elmaradása pedig hátrányosan befolyásolja a betegek rehabilitációját, élet-minőségét, a kognitív funkciókat, illetve a stroke-ot követő mortalitást. Orv. Hetil., 2014, 155(34), 1335-1343.Kulcsszavak: poststroke-depresszió, epidemiológia, befolyásoló tényezők, kezelés, megelőzés Post-stroke depressionCerebrovascular diseases are associated with a high incidence of psychiatric disorders. Depressive illness after stroke has been extensively investigated during the last three decades. Post-stroke depression is estimated to occur in 30-35% of the patients during the fi rst year after stroke. Numerous studies have given information on its prevalence, pathogenesis, clinical course, treatment and prevention. Despite the high level of comorbidity, depressive symptoms appear to remain frequently unrecognized and untreated. This has a negative effect on the rehabilitation, quality of live, cognitive function and mortality of stroke patients. A cerebrovascularis kórképek világszerte népbetegség-nek számítanak. A javuló akut ellátásnak és a stroke-osztályok elterjedésének köszönhetően határozott javulás fi gyelhető meg -főleg a fejlett ipari országokban -az agyvérzést és az agyi ischaemiás keringészavart követő mortalitásban [1]. KeywordsHazánkban az elmúlt években bár a nőknél 13%-kal, a férfi aknál 15%-kal csökkent az agyi érbetegségek okozta halálozás, 2012-ben a stroke férfi aknál a 3. leggyakoribb, nőknél a leggyakoribb halálok volt [2].A stroke és a depresszió kapcsolata epidemiológiailag két szempontból vizsgálható: a depresszió tekinthető-e a stroke kockázati tényezőjének; illetve a stroke után gyakori-e a depresszió, illetve gyakoribb-e, mint a hasonló életkorban jelentkező krónikus korlátozottsággal járó egyéb betegségekben. Az első kérdésre két összefoglaló vizsgálat ad pozitív választ. Hellmann-Regen és munkatársai [3] azt találták, hogy a major depresszió növeli az agyi érkatasztrófa kialakulásának kockázatát és negatív hatással van a stroke kimenetelére. Pan és munkacsoportja [4] egy áttekintő vizsgálatban ugyancsak arra a következtetésre jutott, hogy a depresszió jelenléte szignifi kánsan növeli a stroke morbiditását és mortalitását.

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Disorders of Laughter Due to Brain Lesions

Cited by 136 publications

References 0 publications

Pathological laughter in a patient with trigeminal neurinoma

Pathological laughter in a patient with trigeminal neurinoma

Ictal Smile

Post-stroke depression

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